Iatrogenic acute estrogen deficiency and psychiatric syndromes in breast cancer patients.

The change of estrogen function, represented by amenorrhea or hot flashes, that results from breast cancer treatment may increase the risk of major depressive disorder in those women undergoing treatment for breast cancer. This pilot study describes the course of menopausal symptoms and the incidence of depression in 21 patients who were likely to become acutely estrogen deficient during treatment for breast cancer. These included women who lost menses during chemotherapy, who suddenly stopped estrogen replacement therapy (ERT), or who started tamoxifen. Eight patients (38%) developed major depressive disorder, the majority within 6 months of starting treatment. Twenty patients (95%) had dysphoria and/or insomnia. Fourteen patients (66%) had hot flashes. While this is only pilot data, these data suggest that breast cancer patients whose treatment precipitates menopausal symptoms should be targeted for diagnosis of depression and treated if diagnosed.     

Are there any differences between bipolar and unipolar melancholia?

Although it is now more than 30 years since Leohard originally proposed the distinction between bipolar and monopolar (unipolar) forms of affective disorder, there have been relatively few studies which have investigated clinical features which may differentiate the depressed phase of bipolar disorder from unipolar depression. In this study we examined the value of a new scale for rating depressive mental state signs (the 'core' score system), and a large series of symptoms and risk factors, in distinguishing between 27 age and sex-matched pairs of bipolar and unipolar patients diagnosed as melancholic on several diagnostic criteria. In general, we found a marked similarity between the groups on clinical features of the depressive episode when allowance was made for multiple tests. Bipolar patients, however, had shorter episodes of depression and were less likely to demonstrate 'slowed movements' than unipolar subjects. There were also consistent trends on other items for psychomotor retardation to be less common and agitation to be more likely in the bipolar patients. At the least, these findings suggest that the widely-held belief that bipolar depressed patients typically have psychomotor retardation is not as clear-cut as has been previously described.     

Temperament in bipolar illness: impact on prognosis

OBJECTIVE: The present study was designed to investigate the relations between temperament and outcome in bipolar illness. METHODS: Seventy-two patients presenting with bipolar type I disorder were recruited from consecutive admissions and evaluated when euthymic. The criteria developed by Akiskal and Mallya (Criteria for the 'soft' bipolar spectrum: treatment implications. Psychopharmacol. Bull. 1987;23:68-73) were used to assess both depressive (DT) and hyperthymic temperaments (HT) in a dimensional approach. RESULTS: Multiple regression analysis showed that a higher DT score or a lower HT score were significantly associated with a greater number of episodes. Furthermore, a higher DT score was strongly associated with a higher percentage of major depressive episodes. Conversely, a higher HT score was associated with a trend to manic rather than depressive episodes. Suicide attempts appeared more frequent in the history of patients presenting with higher DT scores. CONCLUSIONS: Our findings strengthen the hypothesis that temperament is one of the main variables accounting for some features in the clinical evolution of bipolar disorder such as polarity of episodes. Furthermore, these findings are consistent with the hypothesis of a trait-state continuum between personality and affective episodes.     

Psychogenic amenorrhea: An integrative review

Psychogenic amenorrhea results from the interaction of intrapsychic vulnerability, external stress, and neuroendocrine disturbances. It may result from exposure to a known stress or may be associated with a major psychiatric disorder. Psychogenic amenorrhea frequently remits spontaneously, particularly when patients eliminate or adapt to external stresses. Various types of psychotherapeutic intervention are effective for more persistent amenorrhea.     

Effectiveness and cost-effectiveness of antidepressant treatment in primary health care: a six-month randomised study comparing fluoxetine to imipramine

BACKGROUND: Over the past decade, studies of the effectiveness of pharmacological treatment for depression have often been based on research designs intended to measure efficacy, and for this reason the results are of limited generalizability. Research is needed comparing the clinical and economic outcomes of antidepressants in day-to-day clinical practice. METHODS: A six-month randomised prospective naturalistic study comparing fluoxetine to imipramine carried out in three primary care health centres. Outcome measures were the Montgomery Asberg Depression Rating Scale (MADRS), direct costs, indirect costs and total costs. Subjects were evaluated at the beginning of treatment and at one, three and six months thereafter. RESULTS: Of the 103 patients, 38.8% (n = 40) were diagnosed with major depressive disorder, 14.6% (n = 15) with dysthymic disorder, and 46.6% (n = 48) with depressive disorder not otherwise specified. Patients with major depressive disorder or dysthymic disorder achieved similar clinical improvement in both treatment groups (mean MADRS ratings decrease in major depressive disorder from baseline to 6 months of 18.3 for imipramine and 18.8 for fluoxetine). For patients with major depressive disorder and dysthymic disorder, the imipramine group had fewer treatment-associated costs (imipramine 469.66 Euro versus fluoxetine 1,585.93 Euro in major depressive disorder, p < 0.05; imipramine 175.39 Euro versus fluoxetine 2,929.36 Euro in dysthymic disorder, p < 0.05). The group with depressive disorder not otherwise specified did not experience statistically significant differences in clinical and costs outcomes between treatment groups. LIMITATIONS: Exclusion criteria, participating physicians may not represent GPs. CONCLUSIONS: In a primary care context, imipramine may represent a more cost-effective treatment option than fluoxetine for treating major depressive disorder or dysthymic disorder. There were no differences in cost-effectiveness in the treatment of depressive disorder not otherwise specified.     

Low prevalence of depressive disorder in ambulatory advanced cancer patients using the Schedules for Clinical Assessment in Neuropsychiatry (SCAN 2.1)

Depressive disorder is assumed to be highly prevalent in advanced cancer patients, but the diagnosis of depressive disorder in patients with advanced cancer is difficult. The more robust the assessment instrument to diagnose depressive disorder is, the lower the reported prevalence of depressive disorder in advanced cancer patients. This study confirms a low prevalence of depressive disorder (3%) in 64 advanced cancer outpatients using a robust structured clinical assessment (SCAN 2.1). Furthermore, in this article we discuss possible implications of using predefined psychiatric labeling in the assessment of mood symptoms in advanced cancer patients.     

Deletion of 7q34-q36.2 in two siblings with mental retardation, language delay, primary amenorrhea, and dysmorphic features

We describe a chromosome rearrangement, ins(7;13)(q32q34;q32), which segregates in a three generation family, giving rise to three individuals with an unbalanced rearrangement. Two of the individuals, a sister and a brother, were investigated further in this study. They had minor facial dysmorphism and neuropsychiatric disorders including mental retardation, language delay and epilepsy. The sister had primary amenorrhea. Array CGH revealed a 12.2?Mb deletion at 7q34-q36.2 including more than 60 genes where CNTNAP2 and NOBOX are of special interest. Comparison of the clinical and cytogenetic findings of our patients with previously reported patients, supports that haploinsuffiency of CNTNAP2 can result in language delay and/or autism spectrum disorder. Furthermore, we report on the second women with a deletion involving NOBOX who is affected by primary amenorrhea.     

Effect of bright white light therapy on non-seasonal depressive disorder. Preliminary results

In this study, the effect of bright white light (2500 lux) and dim light (50 lux) were assessed in 30 patients with non-seasonal major depressive disorder randomly assigned to either procedure. Patients met RDC for major depressive disorder and ICD-9 criteria (296.1 and 296.3). During a 7-day period, the patients were exposed to bright white light (2500 lux) or dim light (50 lux) from 7.00 to 9.00 h daily. The severity of depression was assessed with observer scales (AMDP system, Hamilton depression scale, CGI) and through self-evaluation by self-rating scales (depression scale and list of complaints by von Zerssen). No difference was noted between bright light therapy and dim light, though a significant reduction of depressive symptomatology was observed for all patients during the study. These findings are discussed from a clinical point of view.     

抑郁症临床特征和人格类型研究

目的探讨抑郁症的人格和临床亚型,为预后及治疗方法的选择提供参考。方法对90例抑郁症患者进行明尼苏达多相人格测验(MMPI)测试,采用纪术茂等编制的MMPI-B自动分析系统进行统计分析。结果 1床量表显示:男女抑郁症患者得分最高量表为D;其中Hs、D、Hy、Pt的均分均大于60分,T分(年龄回归T)主要编码型为23/32;男女性患者的差异在于男性患者还伴有病态人格的高分,女性患者还伴男-女性化、社会内向的高分;2内容与附加量表显示:男女抑郁症患者MAS、DEP的均分均大于60分,Es得分均较低;3临床量表,内容量表、附加量表因子分析结果显示抑郁症患者可能具有抑制、动力缺乏型,激越型及以躯体症状为主的隐匿型3种临床亚型。结论抑郁症男、女患者的心理特征既有相同又有不同。     

Psychotic depressive disorder: A separate entity?

Two groups of patients suffering from primary unipolar major depressive disorder, one with (n = 145) and one without (n = 119) psychotic disorders were compared, in order to elucidate whether psychotic depressive disorder represents a distinct subtype or a severe variation of the illness. Except for more frequent appearance of psychomotor disturbances among the psychotic depressives, no demographic, family history and course variables were found to distinguish between those with or without psychotic features. The findings from our study are compatible with the view that psychotic depressive disorder is a severe variant of major depressive illness.     

Association study of nicotinic-receptor variants and major depressive disorder

BACKGROUND: Depressive patients are more likely to smoke than the general population and nicotine was found to reduce the incidence and severity of depressive symptoms in many studies. These findings suggest that nicotinic acetylcholine receptors (nAChRs) may be implicated in major depressive disorder. We tested the hypothesis that the allelic variant, 2 bp deletion, of the partially duplicated alpha7 nAChR gene confers susceptibility to major depressive disorder. METHODS: We genotyped alpha7 nAChR in 72 patients with major depressive disorder and 103 normal controls. Results: The distribution of the partially duplicated alpha7 nAChR genotypes (P=0.027) and alleles (P=0.037) suggests a modest difference between depressive patients and controls. LIMITATIONS: The -2 bp allele is thought to be present only in the duplicated exon 6, and the impact of the partially duplicated alpha7 nAChR and its -2 bp variant remain to be determined. CONCLUSIONS: The -2 bp allele of partially duplicated alpha7 nAChR may have an influence on the risk for development of major depressive disorder. The levels of significance achieved are modest and the findings must be replicated in other studies.     

Bipolar mood disorders among Polish psychiatric outpatients treated for major depression

BACKGROUND: Significant proportion of patients treated for depression may have various types of bipolar mood disorders. The aim of the study was to assess the frequency of bipolar disorders among outpatients having at least one major depressive episode, treated by 96 psychiatrists, representing all regions of Poland. METHODS: The study included 880 patients (237 male, 643 female), identified to following diagnostic categories: bipolar I, bipolar II, bipolar spectrum disorder and major depressive disorder. RESULTS: Bipolar mood disorders were found in 61.2% of patients studied, bipolar I more frequent in men and bipolar II in women, and bipolar spectrum in 12% of patients. Patients with age ranges 19-49 and 50-65 years did not differ as to the percentage of diagnostic categories. Patients with bipolar mood disorders compared to major depressive disorder had significantly more frequent family history of bipolar disorder, premorbid hyper- or cyclothymic personality, early onset of depression, symptoms of hypersomnia and hyperphagia, psychotic depression, post-partum depression, and treatment-resistant depression. Bipolar spectrum patients had most clinical features similar to classic types of bipolar disorders. LIMITATIONS: Neither structured interview for family history, nor formal criteria for a number of clinical manifestations were used. The population treated by psychiatrists may not be representative and present a subgroup with more severe mood disorders. CONCLUSIONS: Bipolar mood disorders may be very prevalent among depressive outpatients treated by psychiatrists in Poland, which is confirmed by the results of recent studies. Bipolar patients (including bipolar spectrum) significantly differ from major depressive disorder as to numerous clinical features related mostly to depressive episode.     

β-HCG检测在拟行131I治疗育龄期女性甲亢患者中的临床意义

目的 探讨β-HCG检测在拟行131I治疗育龄期女性甲亢患者中的临床价值.方法 对拟行131 I治疗的420例育龄期女性甲亢患者的临床资料及血清β-HCG、FT3、FT4、TSH结果进行回顾性分析.结果 18 ～ 35岁年龄段各组的女性甲亢患者β-HCG阳性率比较,差异无统计学意义（P ＞0.05）;36～40岁年龄段组与18 ～ 35岁年龄段组女性甲亢患者β-HCG阳性率比较,差异有统计学意义（P＜0.01）;月经减少、紊乱或闭经组β-HCG水平明显高于月经正常组（P＜0.01）;月经正常组与月经减少、紊乱或闭经组的FT3、TSH4、TSH水平比较,差异无统计学意义（P＞0.05）.结论 月经减少、紊乱或闭经的育龄期甲亢患者更可能合并妊娠,育龄期女性甲亢患者在拟行131I治疗前应常规检测血清β-HCG,防止早孕的漏诊,避免误治.     

Personality disorder, depression and functioning: results from the ODIN study

BACKGROUND: There is little information of the prevalence of personality disorder (PD) in those with depressive disorder in community samples; neither is there any data on the impact of PD on service utilisation or outcome in this setting. METHODS: A two stage screening study to identify cases of depressive disorder using SCAN in five European countries. Personality assessed 6 months after the diagnostic interview. Follow-up for 1 year using symptom and social function measures. RESULTS: Personality disorder is present in 22% of a community sample with depressive disorders but the range varied from 13.7% to 33.3% across countries. Cluster C formed 43% of the total. Long-term psychotropic drug use was more common in the PD group even after depression was controlled. Those with PD had higher symptom scores at the outset and, although the PD group was more likely to be cases at follow-up, this disappeared when the depression score was co-varied. Only initial social function predicted outcome at 6 and 12 months. LIMITATIONS: The use of a non-treatment seeking population may limit the application of the findings to clinical populations. CONCLUSIONS: PD is common even in a non-treatment seeking population with depressive disorder. It impacts upon outcome at 6 and 12 months but this is related to the initial severity of depressed mood. Social function is the only independent predictor of outcome and should be assessed separately.     

A short-term follow-up of patients with depressive disorder on entry into home dialysis training

Fifteen (18%) of 83 patients entering home hemodialysis training were found to suffer major depressive disorder diagnosed by rigorous clinical criteria. The diagnosis of depressive disorder was associated with a diagnosis of polycystic kidney disease. It was not, however, associated with past or family history of affective illness. Neither intellectual impairment nor chemical uremia were more pronounced in the patients with depressive disorder than in the patients without depressive disorder. Depressive symptoms almost invariably remitted during home dialysis training and had no apparent influence on outcome on the basis of a short-term (3-month) follow-up.     

Evaluating the inter-episode stability of depressive mixed states

BACKGROUND: Depressive mixed state (DMX) is understudied, although this diagnostic concept may be of clinical and theoretical importance. Our goal was to provide preliminary evidence of the inter-episode stability of DMX. The inter-episode stability is known to be an important validator for establishing a distinct clinical entity. METHODS: Out of depressive patients consecutively hospitalized at our institute, those who experienced two or more hospitalizations due to discrete depressive recurrences during a 6-year period were selected. All depressive episodes were directly observed and assessed using a standardized rating instrument in terms of eight intra-episode manic symptoms (flight of idea, logorrhea, aggression, excessive social contact, increased drive, irritability, racing thoughts, and distractibility). Assessments for subsequent episodes were performed blindly to those for previous episodes within each patient. RESULTS: The inter-episode stability of categorical DMX diagnoses and the number of intra-episode manic symptoms was moderate but significantly high. Approximately 50% of patients with DMX in the index episode obtained a DMX diagnosis in the second episode. Approximately 40% of the total variance of the number of intra-episode manic symptoms was explained by agreements across several depressive episodes. Depressive patients who experienced a diagnostic switch from unipolar to bipolar disorder had a higher frequency of DMX and a greater number of intra-episode manic symptoms in the index as well as subsequent episodes. LIMITATIONS: All consecutive patients were not followed up. Bipolar I and II patients were combined due to a small number of bipolar II patients in this sample. CONCLUSION: The inter-episode stability of DMX may not be so high as is required for establishing a distinct clinical entity. However, the findings strongly suggest that some depressive patients have a long-lasting liability to DMX. It is important to determine whether such a liability to DMX is mediated by affective temperaments, as was originally hypothesized by Akiskal [J. Clin. Psychopharmacol. 16 (1996) 4S-14S]. DMX may be a risk factor to the diagnostic switch from unipolar to bipolar disorder.     

Serotonin and bipolar disorder

With the emergence of specific pharmacological probes for various serotonin (5-HT) receptors and radio-ligands for central 5-HT, it has now become possible to investigate its role in the pathogenesis of bipolar disorder more closely.This paper critically reviews the scientific literature regarding the relationship between bipolar disorder and serotonergic systems. The evidence suggests that central serotonergic activity is reduced in the depressive phase of bipolar disorder. Similar findings have been reported in bipolar patients when euthymic, indicating that that lower 5-HT activity could be a trait marker for bipolar disorder. Findings reported in the manic phase of this illness are inconsistent.     

Leptin and cholesterol levels are low in major depressive disorder, but high in schizophrenia

BACKGROUND: Appetite, food intake and weight are frequently altered in psychiatric disorders such as major depression and schizophrenia. Leptin is an adipocyte hormone, as the product of the ob gene, regulating food intake and energy balance providing the hypothalamus with information on the amount of body fat. Leptin seems to be strongly associated with lipid metabolism. Moreover, leptin is involved in the control of other behaviors and in brain development. There are few studies about the amounts of plasma leptin in mood disorder and schizophrenia with inconsistent findings. The relationship between leptin and major depressive disorder is still unknown. We planned to investigate the relationship of the serum leptin concentration, cholesterol, and BMI between patients with major depressive disorder, schizophrenic patients and healthy control subjects. METHODS: In the present study, the BMI, plasma cholesterol and leptin levels, BDI, and BPRS were compared in 69 patients with major depressive disorder, 78 schizophrenic patients, and 51 healthy controls. RESULTS: The major findings of our study included (1) leptin and cholesterol levels were low in patients with major depressive disorder, but high in schizophrenic patients; (2) negative correlations between BDI scores and serum cholesterol or leptin levels in the patients with major depressive disorder; (3) an inconsistently positive correlation between mean leptin levels, cholesterol, and BMI among different groups; (4) positive correlations between serum cholesterol or leptin levels and the length of illness in the schizophrenic patients. CONCLUSIONS: In this study, our results indicate that that leptin and cholesterol might play differently important pathophysiological roles in these psychiatric disorders.     

Family history of completed suicide and characteristics of major depressive disorder: a STAR*D (sequenced treatment alternatives to relieve depression) study

BACKGROUND: Clinicians routinely ask patients with non-psychotic major depressive disorder (MDD) about their family history of suicide. It is unknown, however, whether patients with a family member who committed suicide differ from those without such a history. METHODS: Patients were recruited for the STAR*D multicenter trial. At baseline, patients were asked to report first-degree relatives who had died from suicide. Differences in demographic and clinical features for patients with and without a family history of suicide were assessed. RESULTS: Patients with a family history of suicide (n=142/4001; 3.5%) were more likely to have a family history of MDD, bipolar disorder, or any mood disorder, and familial substance abuse disorder, but not suicidal thoughts as compared to those without such a history. The group with familial suicide had a more pessimistic view of the future and an earlier age of onset of MDD. No other meaningful differences were found in depressive symptoms, severity, recurrence, depressive subtype, or daily function. CONCLUSIONS: A history of completed suicide in a family member was associated with minimal clinical differences in the cross-sectional presentation of outpatients with MDD. Limitations of the study include lack of information about family members who had attempted suicide and the age of the probands when their family member died. STAR*D assessments were limited to those needed to ascertain diagnosis and treatment response and did not include a broader range of psychological measures.     

Depressive personality in the relatives of outpatients with dysthymic disorder and episodic major depressive disorder and normal controls.

BACKGROUND: This study examined whether there is a familial relationship between depressive personality and the mood disorders. METHOD: Rates of depressive personality were compared in 161 relatives of outpatients with dysthymic disorder (DD), 75 relatives of outpatients with non-chronic major depressive disorder (MDD), and 90 relatives of normal controls. All probands and relatives were evaluated using structured diagnostic interviews for Axis I disorders and depressive personality traits. RESULTS: The relatives of patients with DD exhibited a significantly higher rate of depressive personality than the relatives of normal controls, while the relatives of patients with MDD fell in between, and did not differ from, the other two groups. These results held after controlling for a lifetime history of mood disorder in the relatives, and could not be explained by an increased rate of depressive personality in the DD probands. LIMITATIONS: The sample size was modest, comorbid non-mood Axis I and II disorders in the relatives were not controlled, and DSM-IV criteria for depressive personality disorder were not yet available at the time the study was undertaken. CONCLUSION: These findings are consistent with the view that depressive personality is part of a spectrum of mood disorders with a shared familial liability, but suggest that this link is strongest with chronic forms of depression such as DD and double depression.